脂肪组织放射学特征与腹腔镜辅助全胃切除术近期疗效关系分析

Association between radiological features of adipose tissue and short-term outcomes and complications after laparoscopic-assisted total gastrectomy for gastric cancer

目的评估皮下脂肪组织(SAT)和内脏脂肪组织(VAT)的放射学特征与腹腔镜辅助全胃切除术后近期疗效的相关性。方法回顾性分析2014年1月至2021年12月复旦大学附属肿瘤医院胃外科收治的180例行腹腔镜辅助全胃切除术的胃腺癌病人的临床资料。Slice-O-Matic 5.0软件计算病人身高校正后的SAT面积(SAT-M)和VAT面积(VAT-M)以及SAT密度、VAT密度,分析其与腹腔镜全胃切除术近期疗效和并发症的关系。结果VAT-M面积与术中出血量、手术时间呈显著正相关(r=0.259、0.225,P<0.01),而与清扫淋巴结数目呈显著负相关(r=-0.257,P<0.01)。SAT-M面积与手术时间呈显著正相关(r=0.152,P<0.05),VAT密度、SAT密度与手术时间呈显著负相关(r=-0.238、-0.149,P<0.05)。按术后有无并发症分组,相较于无并发症组(163例),有并发症组(17例)的VAT-M面积更大[(70.4±20.9)vs.(52.4±24.9),t=2.880,P=0.004],住院时间更长[(23.0±19.5)vs.(8.3±1.8),t=3.108,P=0.007]。Logistic多因素分析显示VAT-M是术后近期并发症的独立危险因素(≥65 cm^(2)/m^(2) vs.<65 cm^(2)/m^(2),OR=5.505,95%CI 1.623-18.669,P=0.006)。结论腹腔VAT的增加延长了手术时间,增加了术中出血量以及术后并发症发生率,是影响手术安全及病人术后恢复的重要因素。

ObjectiveTo evaluate the correlation of radiological features of subcutaneous adipose tissue(SAT)and visceral adipose tissue(VAT)with the short-term outcomes and postoperative complications of laparoscopic-assisted total gastrectomy.MethodsFrom January 2014 to December 2021,a total of 180 patients undergoing laparoscopic-assisted total gastrectomy were included.Slice-O-Matic 5.0 was used to measure the height corrected SAT(SAT-M)and VAT(VAT-M)and adipose tissue density of CT image slices,and the relationship between these variables and the short-term outcomes and postoperative complications were evaluated.ResultsVAT-M area had a significant positive correlation with the intraoperative blood loss and the operation time(P<0.01),while it had a significant negative correlation with the number of retrieved lymph node(P<0.01).SAT-M area showed a significant positive correlation with operation time(P<0.05).VAT density and SAT density showed a significant negative correlation with operation time(P<0.05).Compared with the non-complication group(163 cases),the complication group(17 cases)had larger VAT-M area[(70.4±20.9)vs.(52.4±24.9),t=2.880,P=0.004]and longer postoperative hospital stay[(23.0±19.5)vs.(8.3±1.8),t=3.108,P=0.007)].Multivariate analysis showed VAT-M area was an independent risk factor for postoperative complications(≥65 cm^(2)/m^(2)vs.<65 cm^(2)/m^(2),OR=5.505,95%CI 1.623-18.669,P=0.006).ConclusionA high VAT-M area in gastric cancer patients undergoing laparoscopic-assisted total gastrectomy will increase the difficulty of the operation,prolong the operation time,increase operative bleeding and difficulty of lymph node dissection,and increase the short-term postoperative complications.